Studies Find Race Influences Prescription of Antidepressants

PULLMAN, Wash. — A new study by Washington State University researchers concludes that antidepressants are prescribed to black and Hispanic patients suffering from depression at less than half the rate they are prescribed to similarly diagnosed white patients. The study results are published in an article in the May/June 1999 issue of the Harvard Review of Psychiatry.
Researchers also found that age, gender and insurance coverage are factors in determining access to drugs which are prescribed for patients suffering from depression.
Depression is one of the most common psychiatric disorders. An estimated 11 million Americans, 6 percent of the population, suffer from some form of depression each year. Costs associated with the morbidity and mortality of depression in the United States total an estimated $44 billion annually.
The article, “Ethnicity and the Prescribing of Antidepressant Pharmacotherapy: 1992-1995,” reports the results of a study conducted by David Sclar and colleagues in the College of Pharmacy at Washington State University. Sclar is a professor of health policy and administration, and director of the Pharmacoeconomics and Pharmacoepidemiology Research Unit.
Sclar and his colleagues drew data for their analysis from the National Ambulatory Medical Care Survey for the years 1992 through 1995. The researchers examined physician office visits among persons age 20–79 during the time periods of 1992-1993 and 1994-1995. They found that a diagnosis of depression and the prescribing of an antidepressant increased, per 100 U.S. population, for whites from 6.5 to 7.7, for blacks from 2.6 to 3.4, and for Hispanics from 3.0 to 3.2.
The authors concluded that the rate of physician office visits which resulted in a diagnosis of depression and the prescribing of an antidepressant was comparable among blacks and Hispanics by 1994-1995, but was less than half the rate for whites in either time period examined.
To understand what factors may influence a physician to prescribe an antidepressant, Sclar and colleagues examined data from the 1995 NAMCS. Their report appeared in the December 1998 issue of the International Journal of Psychiatry in Medicine.
The researchers reviewed 18,046,293 physician office visits. They found the factors which were predictive of having been prescribed an antidepressant included younger age, female gender and self-report of depression as a reason for scheduling the office visit.
Moreover, factors predictive of having been prescribed one of the newer antidepressants such as Paxil, Prozac or Zoloft included younger age, female gender, self-report of depression and coverage by private insurance.
These findings, together with results reported in the Harvard Review of Psychiatry, suggest that a greater focus on in-depth screening for depression is required, and that access to antidepressants appears to be a function of patient characteristics and socioeconomic status.
Other researchers participating in the study are Tracy L. Skaer, Linda M. Robison and Richard S. Galin. All are with the Pharmacoeconomics and Pharmacoepidemiology Research Unit at WSU. Sclar is also a member of the research faculty at the Washington Institute for Mental Illness Research and Training. Galin is also affiliated with the University of California at Los Angeles Neuro-Psychiatric Institute.